Adding a low dose of the anesthetic esketamine to a multimodal pain regimen improved the quality of recovery for patients after thoracoscopic lung surgery, while two different regional nerve blocks—erector spinae plane block and intercostal nerve block—provided similar benefits. In a randomized trial of 100 adults, those receiving intravenous esketamine (0.3 mg/kg) scored an average of 111.5 on the quality-of-recovery scale at 24 hours, compared with 105.4 for placebo, a difference exceeding the minimal clinically important threshold of 6.0 points. The esketamine group also had higher scores at 48 hours and hospital discharge. No significant interaction occurred between esketamine and the type of nerve block, and the two blocks yielded comparable recovery scores, suggesting they can be used interchangeably.
Opioid-free anaesthesia (OFA) reduces postoperative nausea and vomiting (PONV) compared with opioid-inclusive anaesthesia in adults undergoing lower extremity wound surgery. In a randomized double-blind crossover trial, 66 patients each received both OFA (lidocaine, esketamine, dexmedetomidine, propofol) and opioid-inclusive anaesthesia (sufentanil, propofol) for two separate surgeries. OFA lowered the incidence of PONV during the first 48 hours after surgery (5% vs. 23%), and also reduced the severity of PONV and rate of hypotension, though time to extubation was longer. Postoperative pain and need for rescue analgesia did not differ between the two techniques.
Opioid-free anesthesia (OFA) combining dexmedetomidine, esketamine, and sevoflurane is being compared with opioid-based anesthesia (OBA) using sufentanil and sevoflurane in a randomized trial of 180 adults undergoing video-assisted thoracoscopic surgery lung resection. The primary outcome is the incidence of chronic postsurgical pain at 3 months. Secondary outcomes include acute pain, pain at 1 and 6 months, opioid consumption, adverse events, and quality of recovery. The hypothesis is that OFA will lower chronic pain rates, reduce adverse events, and improve recovery.